Colloid goitre

Colloid goitres are worldwide, but are very common in areas of iodine deficiency (endemic goitre). They can be prevented by the administration of iodine to the entire community, which also prevents the other manifestations of endemic iodine deficiency (iodine embryopathy, etc.).

Colloid goitres occur between the ages of 20 and 50, and affect women more than men. Large ones obstruct breathing by narrowing or displacing the trachea, and they may occasionally obstruct swallowing. Sometimes, they extend into the thorax. They can be ''simple', in which case they are larger and firmer than a normal thyroid and have a regular surface. More often they are nodular. Although the patient may complain of a single nodule, he usually has more than one, with one lobe of his thyroid much larger than the other. There is no bruit over the nodule unless it is a toxic (hyperthyroid) nodule. Treatment, when it is indicated, is surgical. One of the dangers of a colloid goitre is that bleeding into it may cause it to increase in size suddenly.

COLLOID GOITRE If a colloid goitre is small, and is causing no obvious symptoms, surgery is not really necessary, and the indications for its removal are cosmetic. Discuss this with the patient in the light of the available surgical and anaesthetic skills and priorities.

If he has dyspnoea or dysphagia, or the gland is large, subtotal thyroidectomy is indicated, but is seldom urgent. If there has been a sudden increase due to haemorrhage (unusual) see above.